^(18)F-FDG PET/CT代谢参数结合临床病理指标对皮肤恶性黑色素瘤的预后价值  

Prognostic values of ^(18)F-FDG PET/CT metabolic parameters combined with clinical pathological indicators in cutaneous malignant melanoma

作　　者：安荣臣 王云华[1] 鲁心宇 周廉博 马晓伟 董楚宁 向馨 尹璇 虢红辉 袁佳莹 An Rongchen;Wang Yunhua;Lu Xinyu;Zhou Lianbo;Ma Xiaowei;Dong Chuning;Xiang Xin;Yin Xuan;Guo Honghui;Yuan Jiaying(PET Imaging Center,Department of Nuclear Medicine,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院核医学科/PET影像中心,长沙410011

出　　处：《中华核医学与分子影像杂志》2024年第7期396-400,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^(18)F-FDG PET/CT代谢参数和临床病理指标与皮肤恶性黑色素瘤(CMM)预后的关系。方法回顾性纳入2013年8月至2022年11月于中南大学湘雅二医院行^(18)F-FDG PET/CT显像的100例CMM患者[男62例、女38例,年龄(56.5±2.5)岁],收集其多个临床病理指标[如原发灶部位、TNM分期、前哨淋巴结(SLN)状态等]及代谢参数[SUVmax、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)、全身MTV(wb-MTV)和全身TLG(wb-TLG)]。采用ROC曲线分析PET参数判断无进展生存(PFS)和黑色素瘤特异性生存(MSS)的界值;采用Kaplan-Meier生存分析、单因素和多因素Cox比例风险回归模型对患者PFS及MSS进行预后分析,并构建列线图生存预测模型。结果ROC曲线分析结果示,原发灶SUVmax(p-SUVmax)、原发灶MTV(p-MTV)、原发灶TLG(p-TLG)、wb-MTV和wb-TLG预测PFS和MSS的界值分别为7.13、2.24 cm^(3)、6.98 g、2.57 cm^(3)、8.04 g和9.09、2.34 cm^(3)、7.44 g、2.24 cm^(3)和9.17 g。单因素分析表明,多个临床病理指标和代谢参数是PFS和MSS的预后危险因素。多因素分析表明,SLN转移[风险比(HR)=2.54,95%CI:1.09~5.90;P=0.030]和wb-TLG>8.04 g(HR=2.58,95%CI:1.17~5.72;P=0.019)是PFS的预后危险因素;SLN转移(HR=4.53,95%CI:1.54~13.35;P=0.006)和wb-TLG>9.17 g(HR=2.48,95%CI:1.26~4.89;P=0.009)是MSS的危险预后因素。基于PET代谢参数(wb-TLG)和临床病理指标(SLN转移)的列线图生存预测模型能较好地预测CMM患者预后。结论临床病理指标和PET参数与CMM患者预后有关。SLN状态对预后十分关键。Objective To discuss the relationship between ^(18)F-FDG PET/CT metabolic parameters and clinical pathological indicators and prognosis in cutaneous malignant melanoma(CMM).Methods A total of 100 CMM patients(62 males,38 females,age(56.5±2.5)years)who underwent ^(18)F-FDG PET/CT scans at the Second Xiangya Hospital of Central South University from August 2013 to November 2022 were retrospectively enrolled.Clinical pathological indicators(such as primary site,TNM staging,sentinel lymph node(SLN)status)and metabolic parameters(SUVmax,metabolic tumor volume(MTV),total lesion glycolysis(TLG),whole-body MTV(wb-MTV),and whole-body TLG(wb-TLG))were collected.ROC curve analyses were used to determine the PET parameters thresholds for progression-free survival(PFS)and melanoma-specific survival(MSS).Kaplan-Meier survival analysis,univariate and multivariate Cox proportional hazards regression models were used to analyze the prognosis of patients′PFS and MSS,and a nomogram survival prediction model was constructed.Results Results of ROC curve analyses showed that the thresholds of SUVmax of primary tumor(p-SUVmax),MTV of primary tumor(p-MTV),TLG of primary tumor(p-TLG),wb-MTV and wb-TLG for predicting PFS and MSS were 7.13,2.24 cm^(3),6.98 g,2.57 cm^(3),8.04 g and 9.09,2.34 cm^(3),7.44 g,2.24 cm^(3),9.17 g,respectively.Results of univariate analysis indicated that several clinical pathological indicators and metabolic parameters were prognostic risk factors for PFS and MSS.Results of multivariate analysis indicated that metastases of SLN(hazard ratio(HR)=2.54,95%CI:1.09-5.90;P=0.030)and wb-TLG>8.04 g(HR=2.58,95%CI:1.17-5.72;P=0.019)were independent prognostic risk factors for PFS,while metastases of SLN(HR=4.53,95%CI:1.54-13.35;P=0.006)and wb-TLG>9.17 g(HR=2.48,95%CI:1.26-4.89;P=0.009)were independent risk prognostic factors for MSS.A nomogram survival prediction model based on PET metabolic parameter(wb-TLG)and clinical pathological indicator(SLN status)can effectively predict the prognosis of CMM patients.Conclusions

关 键 词：黑色素瘤 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 预后 

分 类 号：R739.5[医药卫生—肿瘤] R730.44[医药卫生—临床医学]